Provider Demographics
NPI:1922874544
Name:SEMON, CASSANDRA L (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:L
Last Name:SEMON
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:942 ASH ST
Mailing Address - Street 2:
Mailing Address - City:PRENTICE
Mailing Address - State:WI
Mailing Address - Zip Code:54556-1006
Mailing Address - Country:US
Mailing Address - Phone:715-560-2469
Mailing Address - Fax:
Practice Address - Street 1:1200 NORTH ST
Practice Address - Street 2:
Practice Address - City:RIB LAKE
Practice Address - State:WI
Practice Address - Zip Code:54470-9793
Practice Address - Country:US
Practice Address - Phone:715-427-3220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3123-392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer